Definition Circumference of a particular area of a limb, usually at the widest, largest, or maximum point.
Landmarks Circumference measurements are taken at the widest or largest diameter of the limb (Fig. 8.57) or from a fixed bony point (e.g., 10 cm distal to lower edge of the patella).
In the upper arm the widest point is at the middle of the biceps, just below the insertion of the deltoid.
Position When measuring for maximum circumference, the arm is slightly bent and the lower arm is supported so the muscle is not flexed. The tape-measure is moved up and down until it reaches the widest circumference.
Measurement of the leg for maximum circumference can be done with the patient either standing upright or lying down.
When measuring the circumference of a limb from a fixed point, palpate the point carefully or mark it with an ink pen, then record how far up or down from it the circumference measurement is taken in order to be consistent in subsequent measurements.
Remarks Typical limb circumference values for ages 4-16 years are shown in Fig. 8.58. When limb length or circumference inequalities are present, it is particularly important to measure both sides in a reproduca-ble way, since differential growth can be anticipated.
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